East Tennessee Oral & Maxillofacial Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS1794 Issued in TN

Legal business name

EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC

Practice address

1505 E Lamar Alexander Pkwy
Maryville, TN 37804-5131

Phone

(865) 983-8630

Fax

(865) 981-4914

NPI assigned

Sep 26, 2006

Last updated

Nov 18, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark M. Widloski, DDSNPI 1285631135

Title

Owner/Surgeon

Phone

(865) 983-8630

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark M. Widloski, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1285631135
  Medicare reassignment Care Compare group NPD Authorized official
• Brock D. Evans, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1073785010
  Medicare reassignment Care Compare group NPD
• William Russell May Jr., DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Cleveland, TN
  • NPI 1578798666
  Medicare reassignment Care Compare group NPD
• Troy A Trondson, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1093925497
  Medicare reassignment Care Compare group NPD
• Gregory A Conner, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlottesville, VA
  • NPI 1083785091

  TN

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1174624498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045131",
            "telephone_number": "865-983-8630",
            "fax_number": "865-981-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045131",
            "telephone_number": "865-983-8630",
            "fax_number": "865-981-4914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "WIDLOSKI",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER/SURGEON",
        "authorized_official_telephone_number": "865-983-8630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS1794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3205757",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randi J Earley
• East Tennessee Addiction Specialists
• East Tennessee Clinic of Chiropractic
• East Tennessee Dialysis Center Inc
• East Tennessee Foot Clinic PC
• East Tennessee Senior Care (Home Instead)
• Cynthia J Easter, M.D.
• Easterly Family Medicine
• Jeffery Easterly, MD
• Jeffrey Jennings Eberting, D.M.D.

• Oral and Maxillofacial Surgery (Dentist) in Maryville, TN
• Providers in Maryville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.